UTIs
ET (1 Elderly, 2 Male Infants, 1 Women), RF (6), Mech,
Urine, DX (3 Tests)?
ET:
- Elderly: Enlarged prostate
- Males (Infants): Congenital defects, Vesicoureteral reflux
- Women (shorter urethras colonized by fecal flora)
RF:
- GU malformation
- Obstruction
- Kidney Surgery
- Catheterization
- Diabetes
- Pregnancy
MECH = Ascension of microbes from urethra -> bladder.
URINE:
- WBCs (NOT WBC Casts)
DX:
- Leukocyte Esterase test: + = Bacterial
- Nitrite Test: + = Gram -
- Urease Test: + = Urease-producing bug (eg Klebsiella, Proteus)
- = E coli or Enterococcus
Common Vaginal Infections (3)
- Bacterial Vaginosis (NO INFL)
- Trichomoniasis
- Candida Vulvovaginitis (pH NORMAL)
Bacterial Vaginosis
Causative Bug, Assoc (2),
Chars / Micro Findings (3, incl 2 Clues),
Pres, RX?
Gardnerella vaginalis (Gram - rod, anaerobic).
ASSOC:
- Sexual activity (however not sex-trans)
- Overgrowth of anaerobic bacteria in vagina
FINDINGS: NO Infl
- “Clue cells”
- “Fishy amine odor in KOH”
- pH > 4.5
PRES:
- Thin white/yellow discharge with fishy odor
RX: Metronidazole
Trichomoniasis (Vaginitis)
Causative Bug, Chars / Micro Findings (2), Pres (CLUE + 1), RX?
Trichomonas vaginalis.
FINDINGS: INFL.
- pH > 4.5
- “Strawberry cervix”
PRES: Vaginitis
- “Frothy grey-green foul-smelling” discharge
- Burning + Itching
RX: Metronidazole
** Treat sexual partner **
Candida Vulvovaginitis
Chars / Micro Findings (2), Pres (CLUE + 1), RX?
FINDINGS: INFL.
- Pseudohyphae
- pH NORMAL (4 - 4.5)
PRES:
- “Thick white cottage cheese” discharge
- Painful
RX: -azoles
Non-Specific Chlamydial Urethritis
Pres, Labs, Comp?
PRES:
- Dysuria +↑urinary freq
LABS:
- Sterile Pyuria
COMP:
- Reiter Sx (in HLA-B27 Male)
PID
Causative Bugs (2),
Pres (CLUE + 4), Possible Pres (3),
Comp?
- Neisseria gonorrhoeae (acute)
- Chlamydia trachomatis (subacute- often undiagnosed)
PRES: Onset often follows menses
- Fever
- “Chandelier sign” (cervical motion tenderness)
- Purulent cervical discharge
- Adnexal tenderness + Dyspareunia
- MONOarticular Arthritis
POSSIBLE PRES:
- Endometritis
- Hydrosalpinx / Salpingitis
- Tubo-Ovarian abscess
COMP:
- Fitz-Hugh-Curtis Sx
Salpingitis
Comp (4)?
COMP:
- Adhesions
- Chronic pelvic pain
- Ectopic pregnancy
- Infertility
Condyloma Acuminatum (Genital Warts)
Causative Bug, Assoc, Pres (2), Micro Finding (Clue), RX (2)?
HPV.
ASSOC: Cervical Ca
PRES:
- Papillary / wart-like lesions
- Sessile (permanently attached) or Pedunculated
FINDING: Koilocytotic atypia
RX:
- Imiquimod
- Podophyllin
Syphilis
Causative Bug, DX (2ry + 3ry), RX?
Treponema pallidum.
DX: FTA-Abs
RX: Penicillin
1ry Syphilis
Path (Incubation), Pres, DX?
PATH: 3 week Incubation = Spirochetes spread throughout body.
PRES:
- PAINLESS Chancre (heals within 1-3 months)
DX: Dark-Field Microscopy
2ry Syphilis
Pathogenesis (Timing), Pres (4)?
PATH: Devel 1-2 months after 1ry Syphilis.
PRES:
- Fever
- Lymphadenopathy
- RASH (local or generalized) on palms / soles, lasting 1-3 months
- Condylomata lata
3ry Syphilis
Pathogenesis, Locations Affected (3),
Pres (Char Lesion + 2), Eyes,
Comp?
PATH: Devel in 1/3 of untreated patients.
- CNS: -> Neurosyphilis (meningovascular, paresis, Tabes Dorsalis)
- Heart: -> Obliterative Endarteritis of Vaso Vasorum (Aorta)
- Skin
PRES: Char Lesion = ‘Gumma’: Single or multiple. MC in bone, liver, testes.
- Tabes Dorsalis
- General paresis
EYES: “Argyll Robertson pupil”
COMP:
- Aortitis of vasa vasorum -> Thoracic Aneurysm
Congenital Syphilis
Transmission, Pres (5, incl 4 facial abnormalities), Prev?
TRANS: Mother with 1ry (chancre) or 2ry (dissem rash) Syphilis.
(Trans occurs after 1st trimester)
PRES:
- Hydrops Fetalis / Stillbirth
(if neonate survives)
- Facial abnormalities:
- "Saddle" nose
- Short maxilla
- "Rhagades": linear scars at angles of mouth
- "Hutchinson teeth": notched + widely-spaced central teeth
- Sniffles
- "Saber" shins
- CN 8 deafnessPREV: Treat mother early in pregnancy
Lymphogranuloma Venereum
Causative Bug, Def’n, Pres (3), RX (2)?
Chlamydia trachomatis (serotypes L1-3).
Infection of lymphatics.
PRES:
- Genitals: PAINLESS ulcers + Elephantiasis
- Lymph Nodes: PAINFUL and enlarged (lymphadenopathy)
RX:
- Erythromycin
- Tetracyclines
“ToRCHES” Infections (6)
Def’n, Trans (2 options), Common Pres in Neonate (6)?
- Toxoplasma gondii
- Rubella
- CMV
- HIV
- HSV-2
- Syphilis (1ry or 2ry)
Microbes that pass from mother -> fetus.
TRANS:
- Transplacental
- Delivery (esp HSV-2)
COMMON PRES:
- Neuro abnormalities
- Vision / Hearing problems
- Growth retardation
- Hepatosplenomegaly
- Jaundice
- Thrombocytopenia
